Parent/Guardian #1 Name *

First Name

Last Name

Parent/Guardian #1 Phone *

(###)

###

####

Parent/Guardian #1 Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian #1 Relationship to Child *

Mother

Father

Grandmother

Grandfather

Other

Parent/Guardian #2 Name

First Name

Last Name

Parent/Guardian #2 Phone

(###)

###

####

Parent/Guardian #2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian #2 Relationship to Child

Mother

Father

Grandmother

Grandfather

Other

Student Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Child lives with: *

Both Parents

Mother

Father

Grandmother

Grandfather

Guardian

Other (Please explain in the custody arrangements section)

Please indicate the student's COMPLETED sacraments: *

Certificates for completed sacraments are considered legal documents within the Church. Because of this, we need to ensure our records are aligned with all others. You will need to provide the certificate for each completed sacrament. If spelling is unclear you may have to provide the child's birth certificate.

Baptism

First Reconciliation

First Communion

Confirmation

Please select the programs you are interested in: *

For details on the programs we offer please see the pages under "Faith Formation" on our website.

Faith Formation

Sacramental Preparation

RCIA

Adult Formation

I understand the responsibilities above and am committed to fulfilling them. *

Yes

No

Pick Up Person #1 Name *

First Name

Last Name

Pick Up Person #2 Name

First Name

Last Name

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

In case of an emergency, this person may be contacted and allowed to pick up my child. *

Yes, I authorize this person to be contacted and pick up my child in case of emergency.

No, I do not authorize.

Immaculate Heart of Mary Catholic Church can occasionally use photos of my child to promote the Faith Formation program, children’s choirs, and other church activities. Uses might include a display board, church newsletter, church website, social media, press releases, etc. No names will be used on the website, in social media, or in press releases. Do you give Immaculate Heart of Mary Catholic Church permission to include your child in photos used for the purposes stated above? *

Yes, I give permission.

No, I do not give permission.